Tracheostomy in high-risk patients on ECMO: A bedside hybrid dilational technique utilizing a Rummel tourniquet

• Published in: Surgery open science Vol. 16; pp. 248 - 253
• Main Authors: Donato, Britton B., Sewell, Marisa, Campany, Megan, Han, Ga-ram, Orton, Taylor S., Laitinen, Marko, Hammond, Jacob, Chen, Xindi, Ingersoll, Jasmina, Sen, Ayan, D'Cunha, Jonathan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2023; Elsevier
• Subjects: Anticoagulation; ECMO; Rummel tourniquet; Tracheostomy; ECMO; Rummel tourniquet; POD; FiO2; Tracheostomy; cm; Anticoagulation; Fr; ARDS; ET
• ISSN: 2589-8450; 2589-8450
• DOI: 10.1016/j.sopen.2023.11.010

Traditionally, critically ill patients requiring prolonged mechanical ventilation benefit from a long-term airway, thus necessitating tracheostomy. The widespread application of extracorporeal membrane oxygenation (ECMO) has exponentially increased in recent years, creating a new subset of patients necessitating tracheostomy with significantly increased bleeding risk. We present a hybrid dilational tracheostomy technique utilizing a Rummel tourniquet developed at our institution to mitigate bleeding risk in patients on ECMO necessitating long-term airway. A total of 24 patients on ECMO underwent bedside hybrid dilational tracheostomy with utilization of a Rummel tourniquet from 06/2020 to 01/2022 at our institution. These patients were followed longitudinally and evaluated for postoperative bleeding. Particular attention was paid to anticoagulation regimens pre- and post-operatively. The primary outcome of the study, postoperative bleeding, was observed in four of the 24 study participants (16.67 %). Each of these complications were managed with tightening of the Rummel tourniquet and application of hemostatic packing agents; no operative interventions were required. Anticoagulation was held for a mean time of 4.33 h preoperatively and 5.2 h postoperatively. Our data support this hybrid tracheostomy technique with the addition of a Rummel tourniquet to be a safe and effective adjunct for perioperative hemostasis in high-risk patients necessitating tracheostomy while on ECMO. While this technique was initially developed for critically ill COVID-19 patients, we believe it can be applied to all patients on ECMO to help mitigate perioperative bleeding risk. [Display omitted] •Patients on ECMO necessitating tracheostomy have an increased bleeding risk.•A Rummel tourniquet can be utilized to minimize post-tracheostomy bleeding.•Our data demonstrate this technique to be safe and effective.